P2B238: An Innovative Medical-dental Collaboration to Address Barriers to Pediatric Preventive Dental Care Among Medicaid-enrolled Children

Purpose/Objectives: Tooth decay, the most common chronic disease in U.S. children, disproportionally affects low resourced communities leading to poor long-term health outcomes (Pregnancy and Early Childhood, n.d.). In DC in 2020, 38.5% of Medicaid patients aged 1-20 received preventative dental care (Medicaid, n.d.). The American Dental Association (ADA) created the Community Dental Health Coordinator (CDHC) to increase preventative dental care (Grover, 2014). Aim to incorporate CDHC in two outpatient pediatric sites to increase universal screening for dental health needs from 0 to 50 patients biweekly per site, increase CDHC made dental appointments to 60 biweekly per site, and increase total CDHC program uptake and self-reported patient attendance at dental appointments.

Design/Methods: The CDHC, who is reflective of the community served of primarily Black children and families, was implemented at two community pediatric sites using an iterative plan-do-study-act (PDSA) model. CDHC screened all patients between ages 2 and 18 years at their preventative well visits for dental needs. If family agreed to CDHC support, CDHC addressed barriers to access for prior preventative dental care and made family a dental appointment a community dentist. CDHC followed up with families via phone to verify if family attended the appointment and addressed new barriers if needed. All patients received at least one phone call for follow up. PDSA cycles were to improve CDHC process.

Results: At Site 1 (biweekly), average 47.2 patients universally screened and average 13.8 dental appointments made by CDHC. Total 32.9% accepted CDHC support and 38.9% of patients self-reported attending their dental appointments. (Chart 1) At Site 2 (biweekly), average 46.7 patients universally screened and average 10.3 self-reported attending their dental appointments made by CDHC. Total 22.3% accepted CDHC support and 25.1% self-reported attending their dental appointments. (Chart 2)

Conclusion/Discussion: Collaboration between the dental and medical home offers opportunity to address dental access inequity. Universal screening goals were accomplished, but CDHC uptake was less than expected and differed between site 1 and 2. Study authors hypothesize that response rate differed as site 1 has co-located dental home while site 2 does not.
Patients self-reported attendance at dental appointments due to CDHC intervention were lower rates than expected. Phone follow-up for participants was a difficult method to track dental appointment attendance; this was anticipated but use of a city-wide data health exchange network was not feasible. Of those reached for follow up, many missed appointments were due to same-day scheduling conflicts or acute illness, not systemic problems that could be addressed by CDHC. However, few dental clinics provide age-appropriate dental care in the same neighborhood as the medical home.
Next steps include analysis of qualitive focus groups with patients & providers and integration of dental appointment claims data to inform future opportunities.